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Before the end of the day, Dr. William Moore had stabbed three people.

Dr. Moore, a radiologist at Stony Brook University Hospital in New York, specializes in cryoablation – a procedure that uses frozen needles to numb the nerves that cause chronic pain. In any given day, he performs multiple cryoablations, piercing his patients' skin and driving the needle inches into their bodies to apply the treatment.

“This particular technique has really worked very well because we’re going to the root of the nerve where it’s coming out of the spine,” Moore said.

Chronic nerve pain that interferes with normal life is a relatively common surgical complication affecting about 50 percent of patients who have chest operations, according to a 2008 National Institute of Health manuscript. While inside the body, surgeons can hit sensitive areas, causing the nerves to misfire and send pain signals to the brain. Once that neural pain pathway from the nerve to the brain has been established, it’s permanent, said David Hanscom, MD, an orthopedic surgeon at Swedish Neuroscience Institute in Seattle who specializes in chronic pain. Diseases, physical injuries and inflammation can also result in this type of condition.

When medication and therapy are unsuccessful and doctors are unable to remove the offending nerve – a dangerous and possibly fatal procedure – patients can opt to freeze it.

“In some cases, chronic pain can be incapacitating,” said Robert Suh, MD, a radiologist at the Ronald Reagan University of California Los Angeles Medical Center who also performs cryoablations. “It can be debilitating.”

Doctors use a pain scale to describe the severity of such symptoms. The scale runs from zero (no pain) to a 10 (extreme and disabling). When Gary Gluskin, Moore's first patient, has a chronic pain attack, his pain is beyond 10 – literally off the charts.

Cryoablation Provides Relief for Extreme Cases

Gluskin had surgery to remove infected tissue behind his lungs. The operation damaged six of his thoracic nerves, causing them to go haywire and send pain messages to the brain.

“I can deal with one or two [nerves] going off but when all six go off, the pain is just intense,” Gluskin said. It starts in his chest and sometimes it’s so unbearable he squirms on the carpet, lashing out at furniture. A desk falls into the hallway. A chair crashes to the floor. Some episodes like this last up to 20 minutes. “I can’t see you,” he added. “My eyes are open, but I only see white.”

Moore started practicing cryoablation in 2007 after meeting multiple patients like Gluskin who just weren’t getting better.

“When I met Gary, he hadn’t slept through the night in three to four years,” Moore said. “He was extremely unhappy, and I don’t think it’s unfair to say he was very depressed.”

Cryoablation stops the pain signal by physically damaging the nerve. Nerves are coated by sheaths of basic proteins called myelin. Without this protective outer layer, the nerve can’t communicate with the brain. Freezing the misfiring nerve actually destroys that myelin coating. The damage isn’t permanent – eventually the nerves will rebuild the myelin, but, until then, pain signals stop, and patients get some much-needed relief.

Gluskin has had 11 cryoablations, going in every six to eight months after his nerves have naturally repaired. The former real estate attorney is still on disability, but his pain score has gone down to a five. It’s high enough that he cannot return to work, but low enough that he can participate in his family’s life.

“They can’t undo the nerve damage, so it’s something I have to live with,” Gluskin said. “But it does work.”

No Pain, No Gain: Cryoablation Procedure is Painful

The practice of freezing nerves to reduce chronic pain has been around in various forms since the 1970s. Originally designed for terminal lung cancer patients to make dying less painful, cryoablation has only recently been adopted for use on otherwise healthy people. In the U.S., just a handful of doctors like Moore offer the procedure because it requires access to equipment and a specific skill set that most hospitals lack.

Cryoablation also takes a physical toll on those who opt in. When Gluskin goes for his treatments, which are paid for by his insurance, he must be restrained – tied to a CAT scan machine with surgical tape. Large canisters of helium and argon stand like attendees observing the routine. That’s when Moore brings out the needle, which, in but a moment, will be six inches deep within Gluskin’s back.

The needle is a 17-gauge, which is a little bit smaller than the one doctors use to draw blood. A mixture of helium and argon will flow through the needle, its tip frozen to anywhere between -238 degrees Fahrenheit and -274 degrees Fahrenheit. As the gasses pass through the needle their temperature immediately drops to freeze the nerves.

“It’s like somebody is taking the sharpest red hot poker you can ever get and jamming it into your body," Gluskin said. "That’s what it feels like. You see a whole bunch of stars and colors.”

In other words, getting rid of pain is a painful process.

Gluskin is given sedatives, but he has to be awake for the actual procedure to help Moore locate the nerve. When Gluskin screams in pain, Moore knows he’s on the right track.

“My wife sits outside the room, and she hears the yelling,” Gluskin said.

“I don’t think anyone can prepare you for the discomfort of the procedure,” said Sharon Gluskin, a respiratory therapist at Stony Brook Hospital and Gary Gluskin’s wife. "[But] at least they have something to offer so he can get back to something of a normal life.”

Cryoablation: Worth the Pain?

Not all patients are like Gluskin. Some don’t feel much, if any, discomfort during their procedures, according to Moore. The definition of pain varies from person to person. The placement of the nerve, the patient’s response to the treatment, and their level of tolerance will all affect how they react to cryoablation.

For many, the main problem is post-operative muscle spasms due to contact with a freezing needle. Despite the short-term risks, Moore has never had a patient report any long-term consequences. Although, any time you put a needle in a patient’s body, there is always a risk for bleeding, infection and punctured organs, but the odds of that are small, he added.

Gluskin is not afraid of complications, though it’s difficult for him to schedule appointments with Moore, knowing what he’ll have to go through. But as his body slowly starts to heal, the symptoms creep back and along come the blinding attacks.

“Gary is an extremely good example who comes back even though it’s excruciatingly painful,” Moore said. “If someone is willing to endure significant pain and get months of pain relief afterward it makes it worth it.”

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